Current through Reg. 49, No. 38; September 20, 2024
(a) A Medicaid provider that wishes to
provide services as a qualified hospital or qualified entity under the
Presumptive Medicaid Program must provide notification in the format prescribed
by HHSC.
(b) As defined in
RSA
435.1101, a qualified entity applicant must:
(1) furnish health care items and services
covered under the approved plan and be eligible to receive payments under the
Texas State Plan for Medical Assistance;
(2) be authorized to determine a child's
eligibility to participate in a Head Start program under the Head Start Act;
(3) be authorized to determine a
child's eligibility to receive child care services for which financial
assistance is provided under the Child Care and Development Block Grant Act of
1990;
(4) be authorized to
determine an infant's or child's eligibility to receive assistance under the
special nutrition program for women, infants, and children (WIC) under section
17 of the Child Nutrition Act of 1966;
(5) be authorized to determine a child's
eligibility for medical assistance under the Medicaid State plan, or
eligibility of a child for child health assistance under that State Children's
Health Insurance Program;
(6) be
an elementary or secondary school, as defined in section 14101 of the
Elementary and Secondary Act of 1965 (RSA 8801);
(7) be an elementary or secondary
school operated or supported by the Bureau of Indian Affairs;
(8) be a State or Tribal child support
enforcement agency;
(9) be an
organization that:
(A) provides emergency
food and shelter under a grant under the Stewart B. McKinney Homeless
Assistance Act;
(B) is a State or
Tribal office or entity involved in enrollment in the program under the
following provisions of the Social Security Act: Title XIX; Part A of Title IV;
or Title XXI; or
(C) determines
eligibility for any assistance or benefits provided under any program of public
or assisted housing that receives federal funds, including the program under
section 8 or any other section of the United States Housing Act of 1937
(RSA
1437) or under the Native American Housing
Assistance and Self Determination Act of 1996 (RSA
4101 et seq.); and
(10) Any other entity HHSC so deems, as
approved by the Centers for Medicare and Medicaid Services.
(c) Based on
RSA
435.1110 (b), a qualified hospital is a
hospital that:
(1) is a Medicaid
provider;
(2) assists individuals
in completing and submitting an application for ongoing Medicaid and
understanding any documentation requirements; and
(3) has not been disqualified by HHSC.
(d) A qualified entity
or qualified hospital must demonstrate the capability to make presumptive
eligibility determinations and:
(1) receive
HHSC approval of the criteria in subsections (b) and (c) of this section;
(2) complete training as
prescribed by HHSC; and
(3) enter
into a Memorandum of Understanding as prescribed by HHSC.
(e) HHSC may verify with a third-party agency
that the qualified hospital or qualified entity applicant meets the criteria
specified in subsections (b) and (c) of this section.
(f) HHSC notifies the qualified hospital or
qualified entity applicant of HHSC's approval or disapproval to make
presumptive eligibility determinations.
(g) The qualified hospital or qualified
entity must adhere to the standards as set forth in § 366.261 of this
subchapter (relating to Oversight of Qualified Hospitals and Qualified
Entities).
(h) The qualified
hospital or qualified entity may not delegate to another entity the authority
to determine presumptive eligibility.
